Chapter 78 - Chronic and Recurrent Noninfectious Meningitis

Abstract

Chronic meningitis is defined as cerebrospinal fluid (CSF) pleocytosis for more than 4 weeks in association with clinical signs of meningitis such as headache, fever, and neck stiffness. Recurrent meningitis implies cellular clearing from the CSF between episodes. Chronic or recurrent lymphocytic meningitis can present a diagnostic challenge, particularly when it is the initial manifestation of multisystem disease. The underlying disease processes that can present with these meningitides are varied, but they can be classified into several categories. Infectious causes, particularly viral, fungal, rickettsial, tubercular, and syphilitic, probably are the most common cause and should be aggressively sought via direct culture, polymerase chain reaction (PCR) assays, antibody titers, and antigen presence (such as VDRL). Parameningeal foci of infection such as mastoiditis can also produce a picture of chronic CSF pleocytosis. Noninfectious causes of chronic or recurrent meningitis include a group of less common disorders ( Table 78-1 ). Because the infectious causes are discussed elsewhere, the focus of this chapter is on the noninfectious causes of chronic and recurrent meningitis, including the vasculitides (which are also discussed in detail in other chapters).